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Registration

Members and Patients

Before you register please consider the following information. If you are seeking access to your confidential personal prescription information, you will find that information accessible through the Member Portal. To access the portal please click 'Member Portal' at the very top of this web page. If you are interested in submitting a prescription refill request online for the ProCare Rx Mail Order Pharmacy, please click here.


* This Field is required This Field IS visible on profile Information for: First Name : Please enter your real first name.
This Field IS NOT visible on profile Information for: Middle Name : Please enter your real middle name.
* This Field is required This Field IS visible on profile Information for: Last Name : Please enter your real last name.
* This Field is required This Field IS NOT visible on profile Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
* This Field is required This Field IS visible on profile Information for: Username : Please enter a valid username. No spaces, at least 3 characters and contain 0-9,a-z,A-Z
* This Field is required This Field IS NOT visible on profile Information for: Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required This Field IS NOT visible on profile Information for: Verify Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required This Field IS visible on profile
* This Field is required This Field IS visible on profile
* This Field is required This Field IS visible on profile Information for: Position : Position or Job Function
This Field IS visible on profile Information for: Customer : Please check all that appy.
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Enter Security Code: * This Field is required This Field IS NOT visible on profile Information for: Security Code: : Enter Security Code from image. If no image is present then try disabling your advertisement blocker and then refresh this page. Otherwise please contact the website administrator for assistance.
 
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